A search for point sources of EeV neutrons

A thorough search of the sky exposed at the Pierre Auger Cosmic Ray Observatory reveals no statistically significant excess of events in any small solid angle that would be indicative of a flux of neutral particles from a discrete source. The search covers from -90 degrees to +15 degrees in declination using four different energy ranges above 1 EeV (10(18) eV). The method used in this search is more sensitive to neutrons than to photons. The upper limit on a neutron flux is derived for a dense grid of directions for each of the four energy ranges. These results constrain scenarios for the production of ultrahigh energy cosmic rays in the Galaxy.

LARGE-SCALE DISTRIBUTION OF ARRIVAL DIRECTIONS OF COSMIC RAYS DETECTED ABOVE 10(18) eV AT THE PIERRE AUGER OBSERVATORY

A thorough search for large-scale anisotropies in the distribution of arrival directions of cosmic rays detected above 10(18) eV at the Pierre Auger Observatory is presented. This search is performed as a function of both declination and right ascension in several energy ranges above 10(18) eV, and reported in terms of dipolar and quadrupolar coefficients. Within the systematic uncertainties, no significant deviation from isotropy is revealed. Assuming that any cosmic-ray anisotropy is dominated by dipole and quadrupole moments in this energy range, upper limits on their amplitudes are derived. These upper limits allow us to test the origin of cosmic rays above 10(18) eV from stationary Galactic sources densely distributed in the Galactic disk and predominantly emitting light particles in all directions.

Measurement of the proton-air cross section at root s=57 TeV with the Pierre Auger Observatory

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505 +/- 22(stat)(-36)(+28)(syst)] mb is found.

The phenotype of Floating-Harbor syndrome: clinical characterization of 52 individuals with mutations in exon 34 of SRCAP

Background Floating-Harbor syndrome (FHS) is a rare condition characterized by short stature, delays in expressive language, and a distinctive facial appearance. Recently, heterozygous truncating mutations in SRCAP were determined to be disease-causing. With the availability of a DNA based confirmatory test, we set forth to define the clinical features of this syndrome. Methods and results Clinical information on fifty-two individuals with SRCAP mutations was collected using standardized questionnaires. Twenty-four males and twenty-eight females were studied with ages ranging from 2 to 52 years. The facial phenotype and expressive language impairments were defining features within the group. Height measurements were typically between minus two and minus four standard deviations, with occipitofrontal circumferences usually within the average range. Thirty-three of the subjects (63%) had at least one major anomaly requiring medical intervention. We did not observe any specific phenotype-genotype correlations. Conclusions This large cohort of individuals with molecularly confirmed FHS has allowed us to better delineate the clinical features of this rare but classic genetic syndrome, thereby facilitating the development of management protocols.

Synthese von flüssigkristallinen Polysiloxanen und Charakterisierung der smektischen Phasen

Gegenstand dieser Arbeit ist die Untersuchung der smektischen Phasen von Polysiloxanen mit flüssigkristallinen Seitengruppen (LC-Polysiloxane). Der erste Teil der vorliegenden Arbeit befasste sich mit der Herstellung verschiedener flüssigkristalliner ferroelektrischer Polysiloxane. Die Polymere wurden in Bezug auf das verwendete Polymerrückgrat (Homo- und Copolysiloxan) sowie durch den zusätzlichen Einbau von vernetzbaren Seitengruppen variiert. Im zweiten Teil der Arbeit wurden die Eigenschaften der smektischen Phasen der hergestellten Substanzen näher untersucht. Ein erster Untersuchungsgegenstand war das Dehnungsverhalten von freistehenden flüssigkristallinen Elastomerfilmen (LCE). Bei der Verwendung eines Polymers, in dem nur ein Teil des Polysiloxanrückgrats mit Seitengruppen substituiert ist, wird die uniaxiale Dehnung des Films parallel zu den smektischen Schichten durch eine gleichmäßige Kontraktion in der Filmebene und parallel zur Schichtnormalen ausgeglichen, was auf einen außergewöhnlich niedrigen smektischen Schichtkompressionsmodul zurückzuführen ist. Im Gegensatz dazu ist dieser Modul bei den Homopolymersystemen so groß, dass praktisch senkrecht zu den smektischen Schichten keine Kontraktion stattfindet. Ein zweiter Untersuchungsgegenstand der Netzwerkbildung bestand in der Bestimmung der dynamisch-mechanischen Eigenschaften der LC-Polysiloxane mittels eines Oszillationsrheometers. Hier erfolgten die Messungen von Speicher- und Verlustmodul in Abhängigkeit vom Polymerrückgrat und von der Vernetzung. Die unvernetzten Systeme zeigten in den smektischen Phasen (oberhalb Tg) noch – im wesentlichen – Festkörpereigenschaften (physikalische Vernetzung) mit einem dominierenden Speichermodul beim LC-Homopolysiloxan. Beim LC-Copolysiloxan haben beide Module eine gleiche Größenordnung. Am Phasenübergang in die isotrope Phase wurden beide Module absolut kleiner, der Verlustmodul aber relativ größer. In der isotropen Phase verhalten sich die LC-Polymere damit überwiegend wie viskose Schmelzen. Außerdem korrelierten die mittels DSC bestimmten Phasenübergangstemperaturen mit einer Änderung der dynamisch-mechanischen Eigenschaften. Nach der Vernetzung dominierte der Speichermodul sowohl beim LC-Homo- als auch beim LC-Copolysiloxan bis in die isotrope Phase, und es war aufgrund der Bildung einer festen Netzwerkstruktur keine Abhängigkeit der Module von Phasenübergängen mehr erkennbar. Als dritter Untersuchungsgegenstand wurde der Phasenübergang zwischen den beiden smektischen Phasen (SmC* nach SmA*) der flüssigkristallinen Polysiloxane näher behandelt. Als wichtigstes Ergebnis ist festzuhalten, dass die verdünnten LC-Polysiloxane an diesem Übergang fast keine Schichtdickenänderung aufweisen. Dazu wurde jeweils die röntgenographisch ermittelte Schichtdicke mit der aus den optischen Tiltwinkeln theoretisch berechneten Schichtdicke verglichen. Dadurch konnte gezeigt werden, dass sich die Phasenübergänge nach dem de Vries-Modell verhalten. Damit konnte zum ersten Mal an Polymersystemen ein de Vries-Verhalten nachgewiesen werden. Im Gegensatz dazu zeigte das Homopolysiloxan mit dem Dreiringmesogen beim Übergang von SmC* nach SmA* einen ausgeprägten Sprung in der Schichtdicke. Wie auch durch DSC-Messungen nachweisbar, lag ein Phasenübergang 1. Ordnung vor. Bei den LC-Copolysiloxanen liegt dagegen ein Phasenübergang 2. Ordnung vor. Schließlich wurde die Schichtdicke unter dem Einfluss der Vernetzung untersucht. Beim LC-Copolysiloxan mit dem Dreiringmesogen und einem Anteil an vernetzbaren Gruppen von 15 % wurde eine Stabilisierung der smektischen Phasen erreicht. Zum einen war die Änderung der Schichtdicke am SmC*-SmA*-Phasenübergang geringer im Vergleich zum unvernetzten System und zum anderen war noch 50 °C über der ursprünglichen Klärtemperatur eine smektische Schichtstruktur röntgenographisch nachzuweisen. Insgesamt ist es mit den verschiedenen Untersuchungsmethoden gelungen, einen systematischen Unterschied zwischen smektischen Homo- und Copolysiloxanen aufzuzeigen, der seinen Ursprung – aller Wahrscheinlichkeit nach – in der Mikrophasenseparation von Mesogenen und Polysiloxanketten findet.

The impact of body mass index on the one year outcomes of patients treated by percutaneous coronary intervention with Biolimus- and Sirolimus-eluting stents (from the LEADERS Trial)

The aim of this analysis was to assess the effect of body mass index (BMI) on 1-year outcomes in patients enrolled in a contemporary percutaneous coronary intervention trial comparing a sirolimus-eluting stent with a durable polymer to a biolimus-eluting stent with a biodegradable polymer. A total of 1,707 patients who underwent percutaneous coronary intervention were randomized to treatment with either biolimus-eluting stents (n = 857) or sirolimus-eluting stents (n = 850). Patients were assigned to 1 of 3 groups according to BMI: normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 1 year, the incidence of the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was assessed. In addition, rates of clinically justified target lesion revascularization and stent thrombosis were assessed. Cox proportional-hazards analysis, adjusted for clinical differences, was used to develop models for 1-year mortality. Forty-five percent of the patients (n = 770) were overweight, 26% (n = 434) were obese, and 29% (n = 497) had normal BMIs. At 1-year follow-up, the cumulative rate of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was significantly higher in the obese group (8.7% in normal-weight, 11.3% in overweight, and 14.5% in obese patients, p = 0.01). BMI (hazard ratio 1.47, 95% confidence interval 1.02 to 2.14, p = 0.04) was an independent predictor of stent thrombosis. Stent type had no impact on the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization at 1 year in the 3 BMI groups (hazard ratio 1.08, 95% confidence interval 0.63 to 1.83, p = 0.73). In conclusion, BMI was an independent predictor of major adverse cardiac events at 1-year clinical follow-up. The higher incidence of stent thrombosis in the obese group may suggest the need for a weight-adjusted dose of clopidogrel.

The twelve-month outcomes of a biolimus eluting stent with a biodegradable polymer compared with a sirolimus eluting stent with a durable polymer

This study reports the 12-month clinical outcomes of the LEADERS clinical trial which compared a biolimus eluting stent with a biodegradable polymer (BES) to a sirolimus eluting stent with a durable polymer (SES).

A comparison of the conformability of everolimus-eluting bioresorbable vascular scaffolds to metal platform coronary stents

The aim of this study was to assess the differences in terms of curvature and angulation of the treated vessel after the deployment of either a metallic stent or a polymeric scaffold device.

Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial

OBJECTIVES: We aimed to assess the predictive value of the SYNTAX score (SXscore) for major adverse cardiac events in the all-comers population of the LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial. BACKGROUND: The SXscore has been shown to be an effective predictor of clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention. METHODS: The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the LEADERS trial (patients after surgical revascularization were excluded). Post hoc analysis was performed by stratifying clinical outcomes at 1-year follow-up, according to 1 of 3 SXscore tertiles. RESULTS: The 1,397 patients were divided into tertiles based on the SXscore in the following fashion: SXscore8 and 16 (SXhigh) (n=461). At 1-year follow-up, there was a significantly lower number of patients with major cardiac event-free survival in the highest tertile of SXscore (SXlow=92.2%, SXmid=91.1%, and SXhigh=84.6%; p<0.001). Death occurred in 1.5% of SXlow patients, 2.1% of SXmid patients, and 5.6% of SXhigh patients (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 1.29 to 3.01; p=0.002). The myocardial infarction rate tended to be higher in the SXhigh group. Target vessel revascularization was 11.3% in the SXhigh group compared with 6.3% and 7.8% in the SXlow and SXmid groups, respectively (HR: 1.38, 95% CI: 1.1 to 1.75; p=0.006). Composite of cardiac death, myocardial infarction, and clinically indicated target vessel revascularization was 7.8%, 8.9%, and 15.4% in the SXlow, SXmid, and SXhigh groups, respectively (HR: 1.47, 95% CI: 1.19 to 1.81; p<0.001). CONCLUSIONS: The SXscore, when applied to an all-comers patient population treated with drug-eluting stents, may allow prospective risk stratification of patients undergoing percutaneous coronary intervention. (LEADERS Trial Limus Eluted From A Durable Versus ERodable Stent Coating; NCT00389220).

A randomised comparison of novolimus-eluting and zotarolimus-eluting coronary stents: 9-month follow-up results of the EXCELLA II study

Novolimus, a macrocyclic lactone with anti-proliferative properties, has a similar efficacy to currently available agents; however it requires a lower dose, and less polymer, and is therefore conceivably safer.

The outcome of bifurcation lesion stenting using a biolimus-eluting stent with a bio-degradable polymer compared to a sirolimus-eluting stent with a durable polymer

This study investigated the differences in clinical outcomes between patients with bifurcation lesions (BL) treated with a biolimus-eluting stent (BES) with a biodegradable polymer, and a sirolimus-eluting stent (SES) with a durable polymer.

Implantation of the biodegradable polymer biolimus-eluting stent in patients with high SYNTAX score is associated with decreased cardiac mortality compared to a permanent polymer sirolimus-eluting stent: two year follow-up results from the "all-comers" LEADERS trial

Background: The SYNTAX score (SXscore) has been shown to be an effective predictor of clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods and results: The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the “all-comers” LEADERS trial (patients post-surgical revascularisation were excluded). Post hoc analysis was performed by stratifying clinical outcomes at two-year follow-up, according to one of three SXscore tertiles: SXlow ≤8 (n=464), 816 (n=461). At two-year follow-up the rate of major adverse cardiovascular events was 18.4%, 12.0% and 9.4% in the SXhigh, SXmid, and SXlow tertile, respectively (HR 1.45; CI 1.21-1.74; p<0.01). There was a significantly higher rate of cardiac death in patients in the highest SXscore tertile (7% SXhigh versus 2.4% SXmid versus 1.8% SXlow; HR 2.22; CI 1.5-3.27; p<0.001). Within the SXhigh tertile the rate of cardiac death was significantly lower in patients treated with the biolimus-eluting stent compared with the sirolimus-eluting stent (4.7% versus 9.6%, HR 0.48; CI 0.23-0.99; p=0.046). Conclusions: The SXscore when applied to an “all-comers” patient population allows for prospective risk stratification of patients undergoing PCI up to two years follow-up. In addition, the SXscore appears to separate the performance of devices in high risk patient groups.

A patient-level pooled analysis assessing the impact of the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score on 1-year clinical outcomes in 6,508 patients enrolled in contemporary coronary stent trials

This study sought to assess the impact of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SXscore) on clinical outcomes in patients undergoing percutaneous coronary intervention.